2016 Benefits at a Glance

Flexible Benefits for 2016 Plan Year
Vendor
Dental
DHMO
Dental Select
&
Dental Select Plus
Vision Select
&
Vision Select Plus
Cigna
Delta Dental
Blue Cross Blue
Shield of Ga.
1-800-642-5810
1-866-496-2384
1-855-556-4844
Contact
Numbers
Employee (EE)
EE + Spouse
EE + Child(ren)
EE + Family
Employee (EE)
EE + Spouse
EE + Child(ren)
EE + Family
Employee (EE)
EE + Spouse
EE + Child(ren)
EE + Family
DHMO
Employee (EE)
$21.74
EE + Spouse
$39.59
EE + Child(ren)
$49.09
EE + Family
$58.55
SELECT
Employee (EE)
EE + Spouse
EE + Child(ren)
EE + Family
SELECT PLUS
Employee (EE)
EE + Spouse
EE + Child(ren)
EE + Family
Enhancement:
Added Dentists
in the Augusta,
Cartersville,
Lawrenceville,
Macon,
Savannah &
Valdosta Areas.
Modification:
Select and Select Plus
Plans rate has
increased by 10% with
no plan changes.
Coverage
Tiers
Rate Tier
Changes
for 2016
Eligibility
SELECT
Employee (EE) $4.54
EE + Spouse $9.49
EE + Child(ren) $9.92
EE + Family $13.37
SELECT PLUS
$42.01 Employee (EE) $ 7.73
$82.22 EE + Spouse $16.80
$86.24 EE + Child(ren) $17.57
$121.01 EE + Family $23.90
$26.20
$51.03
$53.49
$74.95
Employee Life,
Accidental
Spouse and
Death &
Child Life
Dismemberment
Short Term
&
Long Term
Disability
Specified Illness
Select
Specified Illness
& Accident Select
Plus
Long Term Care
Legal Select
&
Legal Select
Plus
FSA {Health &
Dependent
Care}
1-800-893-0763
Metlife
MetLife
The Standard
AFLAC/CAIC
AFLAC/CAIC
Unum
Hyatt Legal
Plans
1-877-255-5862
1-800-821-6400
(Estate Resolution)
*Employee:
1x to 10x Benefit
Salary: Max
Coverage is
$2,000,000
*Spouse Levels:
$6K, $12K, $30K,
$60K, $100K,
$150K, $200K,
$250K
*Child Levels:
$3K, $6K, $10K,
$15K, $20K
*Employee:
Based on Age,
Salary, and
Coverage
Selection
*Spouse:
Based on
Employee's Age,
Salary, and
Coverage
Selection
*Child Rates:
$3000 - $0.92
$6000 - $1.14
$10,000 - $1.44
$15,000 - $1.81
$20,000 - $2.18
1-877-255-5862
1-800-821-6400
(Estate Resolution)
*Employee:
1x to 10x Benefit
Salary: Max
coverage is
$2,000,000
(Spouse or
Child(ren) not
eligible for
coverage
1-888-641-7186
1-800-433-3036
1-800-433-3036
1-888-764-3539
1-800-821-6400
*Based on
Employee's
Coverage Selection
(0.020 per thousand
+admin fee
STD: 7 Day or 30
Day wait
(Employee only)
LTD:
(Employee only)
*Employee:
$5K, $10K, $20K,
$30K, $40K, $50K
* Spouse:
$5K, $10K, $20K,
$30K, $40K, $50K
* Child:
50% of Employee's
coverage (automatic)
*Employee:
$5K, $10K, $20K,
$30K, $40K, $50K
* Spouse:
$5K, $10K, $20K,
$30K, $40K, $50K
* Child:
50% of Employee's
coverage (automatic)
* Based on
Employee's Age,
Salary, Social
Security Eligibility,
and Retirement
eligibility + admin
fee
*Based on
AFLAC/CAIC's
premium rate chart.
*Employee:
Guaranteed Issue up
to $30K + admin fee
*Spouse: Rate will be
based on the
employee's age +
admin fee
*Child: Coverage is
provided at no
additional cost
*Based on
*Based on Unum's
SELECT
AFLAC/CAIC's
premium rate chart + Employee
$6.37
premium rate chart.
admin fee
Family
*Employee:
$8.00
Guaranteed Issue up
SELECT PLUS
to $30K + admin fee
Employee
*Spouse: Rate will be
$8.00
based on the
Family
employee's age +
$10.30
admin fee
*Child: Coverage is
provided at no
additional cost
Long term care
days of deciding
and completing
forms after
(termination,
resign, and/or
retirement) has
gone from 30-45
days.
Benefits will begin the first day of the month after one full calendar month of employment
*Employee Only*
*** A Spouse,
Parent, and / or
Parent-in-law may
enroll in an
individual policy
directly with the
vendor
Modification:
Plan has increased
by 9-15% with no
plan changes.
Employee (EE)
EE + Family
Enhancement:
Hyatt Legal has
added the Identity
Theft and Debt
Collection Defense
to both the Select
and the Select Plus
Plan
ADP
*Employee and any
eligible dependents
*Monthly
contributions are
determined by the
employee. Please
refer to the website
for minimum and
maximum
contribution
amounts*. + monthly
admin fee of $3.20
will apply to the
Health Care
Spending Account
only. *Must elect
during AE to
participate
Enhancement:
Maximum
contribution
amount has
increased from
$2460.00 to
$2510.00.

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